Apparatus, system and methods for proper transesophageal echocardiography probe positioning by using camera for ultrasound imaging

ABSTRACT

An apparatus, system and methods that comprise adding a removable or detachable carrier containing a camera and illumination to a TEE probe, thereby allowing the user to view the placement of the probe and minimize or reduce the risk of esophageal and pharyngeal complications during the positioning of the TEE probe into the patient&#39;s esophagus. The reduction or minimization of complications occurs by allowing the cardiologist direct visualization of pharyngeal and esophageal structures during intubation. This device and procedure eliminate any “blind procedure”, whereby direct visualization of the pharyngeal structures and esophagus present a possible solution to these mechanical complications. Once the TEE probe has been properly positioned in the esophagus, the carrier is removed from the esophagus. The removable or detachable camera of the present disclosure can be used in other industries.

CROSS-REFERENCE TO RELATED APPLICATIONS

The application is a continuation of International Application No.PCT/US2015/062701, filed Nov. 25, 2015, entitled “Apparatus, System AndMethods For Proper Transesophageal Echocardiography Probe Positioning ByUsing Camera For Ultrasound Imaging,” which claims priority to and thebenefit of U.S. Provisional Patent Application Ser. No. 62/084,969,filed Nov. 26, 2014, entitled “Apparatus, System And Methods For ProperTransesophageal Echocardiography Probe Positioning By Using Camera ForUltrasound Imaging,” the disclosures of which are incorporated herein intheir entirety.

FIELD OF THE INVENTION

The present disclosure relates generally to a TransesophagealEchocardiography Endoscopic Camera Assist Device (TEECAD) for addingdirect visualization to Transesophageal Echocardiography intubation(TEE), without having to develop a completely new TEE probe nor withoutthe need to revamp existing echocardiography machines. In particular,the present disclosure comprises an attachable TEECAD probe, which isconfigured to be attached to an existing TEE probe prior to intubation.The TEECAD probe contains a camera and a light source, which will feedinto a video monitor and allow the user or practitioner to visualize thepath of the TEE probe as it is inserted into the esophagus and movedinto position for the procedure. The TEECAD probe would add minimalwidth or girth to the TEE probe, and would be completely detachable andeasily retractable after successful intubation of the esophagus, whileleaving the probe in the proper location.

BACKGROUND OF THE INVENTION

Echocardiography, is a diagnostic modality that utilizes a transducer totransmit ultrasound waves to the heart, which deflect or rebound off thestructures of the heart. A computer converts the resulting waves anddisplays them on a screen as 2 dimensional, 3 dimensional, or dopplerwave images, which allow assessment of cardiac structure and function.The majority of echocardiograms are obtained from a transthoracicapproach (TTE), which generally gives an excellent assessment of leftventricular and valvular structure and function. Transesophagealechocardiography similarly takes echocardiographic pictures of theheart, but the images are obtained behind the heart from the esophagus,rather than across the chest wall. The TEE approach is advantageous overTTE's in many circumstances, most commonly for optimal imaging of heartvalves, assessing for left atrial appendage thrombus, examination ofintracardiac tumors, and assessment for intracardiac shunting.

The TEE procedure offers a much clearer image of certain heartstructures versus a standard TTE. The TEE probe is comprised of aflexible endoscope with ultrasound transducer at the tip. The probe isinserted into the mouth and advanced into the esophagus. From theesophageal position, the ultrasound beam does not have to travel throughthe chest wall, and therefore offers a much clearer image of several keyheart structures, especially the atria and valves, that may not be seenas clearly with a TTE. During the procedure, the cardiologist can rotatethe endoscope and examine the heart from different angles.

An example of an optical TEE probe is disclosed in U.S. Pat. No.6,884,220, titled Optical Transesophageal Echocardiography Probe (Aviv,et al.), where the proposed probe contains an optical imaging element, asuction channel, and a light channel for illumination, among otherelements. The disclosure relates to an optical TransesophagealEchocardiography probe having an optical fiber bundle to allow real-timevisualization of the structures that are transverse as the device ispassed via the mouth into the esophagus, wherein the probe has a uniqueprofile which allows passage into the esophagus with a minimum amount oftrauma to the patient.

Another disclosure, U.S. Pat. No. 4,327,738, titled Endoscopic Method &Apparatus Including Ultrasonic B-Scan Imaging (Green, et al.), disclosesan endoscopic method and apparatus for the simultaneous visual andultrasonic imaging of internal body parts through the use of a probeinsertable into a body cavity. The probe includes a rectilineartransducer array acoustically coupled to the body through a cylindricalfocusing lens having an outer face that conforms to the probe contour.An optical illuminating and viewing system is provided for opticallyviewing internal body parts through the probe, which includes anobjective lens and illuminating means adjacent the distal ends of theprobe and the transducer array. A removable eyepiece at the housing isused for direct viewing by the operator while guiding the probe intodesired position in the body cavity. Means also are provided for viewingthe optical image by a video camera having an output connected to amonitor adjacent the ultrasonic image display. Consequently, both theoptical and ultrasonic images are simultaneously displayable andviewable by the operator.

Another disclosure, U.S. Pat. No. 4,567,882, titled Method For LocatingThe Illuminated Tip Of An Endotracheal Tube (Heller), discloses amedical tube with a fiber optic light conductor extending lengthwisethrough the wall of the tube, with the conductor ending in a lightemitting and redirecting terminus adjacent the tube's distal end. In thedisclosure, light emitted laterally from the tip of the tube may bevisually and externally observed through the body wall of the patientfor accurately and quickly determining the anatomical location of thattip.

One of the disadvantages of the TEE procedure is that the cardiologistinserts the flexible endoscope without being able to see where the scopeis going. The procedure is usually done by feel and experience, andalthough most of these procedures occur without problems, a smallpercentage of these procedures can result in oropharyngeal, esophageal,or gastric trauma, which can be catastrophic complications with highmortality rates. To the extent a camera or other device for viewing theprocedure is used, the device must be modified from its original design,which can be expensive, or the new design might create a scope that ismuch larger in width or girth, making the procedure more uncomfortablefor the patient.

Thus, there is a need for a camera and light source device or camerasystem and methods in which the camera system is configured to beattached to a TEE probe or scope and disconnected or detached from theprobe once the transducer at the end of the scope has been placed in theproper position for the procedure. Once in the proper location, thecamera system can be removed from the patient prior to the procedure.The present disclosure solves these and other disadvantages of the priorart.

SUMMARY OF THE INVENTION

The present disclosure solves the disadvantages of, and improves on, theprior art systems as described herein. The present disclosure pertainsto a device, system and methods that comprise adding a removable ordetachable camera to a TEE probe, for example, by using a carriercomprised of a proximal component, a mid-section lumen and a distalcomponent, and in which the distal component is configured to removeablyattach to the distal end of the TEE probe. The distal component houses acamera and light source or LED and associated wiring back to theproximal component through the mid-section lumen for connection to avideo monitor to allow the practitioner to view the placement of the TEEprobe in the patient, thereby minimizing or reducing the risk ofesophageal and pharyngeal complications during the positioning of theTEE probe into the patient's esophagus. The reduction or minimization ofcomplications occurs by allowing the cardiologist direct visualizationof pharyngeal and esophageal structures during intubation. This deviceand procedure eliminates any “blind procedure”, whereby directvisualization of the pharyngeal structures and esophagus present apossible solution to these mechanical complications. Once the TEE probeis properly located, the carrier can be removed from the TEE probe andextracted from the patient.

Currently, during a TEE procedure, the probe is positioned in thepatient's esophagus, usually under conscious sedation and with localanesthetic applied to the oropharynx. Intubation of the esophagus isalmost always done without imaging assistance, and is essentially a“blind” procedure, done by operator feel and assisted by the patientswallowing at the appropriate time. Reported complication rates aregenerally low, with the most catastrophic potential complication beingperforation of the esophagus or damage to pharyngeal structures.

While the reported complication rates appear low, these rates are likelyto change as the risk profile of patients undergoing TEE evolves,especially with the advancing age of patients undergoing TEE, which willalmost certainly lead to an increase in TEE related complications, suchas esophageal and pharyngeal perforation, and accidental trachealintubation. Current advances in cardiology, most notably catheter basedvalve interventions for “inoperable” patients, are creating a sizeablepool of elderly, high risk patients who generally need screening TEE'sto qualify for said procedures, as often also pen-procedural TEE's.

A device, system and methods that provide the above-noted advantages isthe TEECAD, a Transesophageal Echocardiography Endoscopic Camera AssistDevice, which offers a way to allow the cardiologist directvisualization for TEE intubation, without having to develop a completelynew TEE probe or revamp existing echocardiography machines toaccommodate the technology. As detailed herein, the TEECAD devicecomprises a carrier with a camera and light source device and systemthat is configured to be attached to, and when necessary, removed from,an existing probe. The carrier or attachment device can be furtherconfigured with wiring to transmit information to a video monitor, whichmay be separate from the echocardiography machine. The device can alsobe used with an eyepiece for the cardiologists to look into during theplacement of the probe. An advantage to the TEECAD device is the minimaladded width and/or girth on the TEE probe, and the device is configuredto be detachable from the probe and easily retractable after successfulintubation of the esophagus.

In the preferred embodiment, the TEECAD device would consist of acarrier comprising a proximal component, a mid-section lumen and adistal component, and in which the distal component is of a shape andform to removeably attach to a TEE probe. The proximal component wouldbe configured as a handle for the practitioner to hold or as a clip tobe attached to the proximal end of the TEE probe. The distal componentis configured to house a camera and light source and allow theassociated wiring for those items to snake back through the mid-sectionlumen and the proximal component for connection to a video chip, videomonitor or image processor as understood by one having ordinary skill inthe art.

This configuration allows the practitioner to view the placement of theTEE probe in the patient as the TEECAD device would be configured tofeed video of the probe placement (in the esophagus) on a separateportable monitor, which can be placed near the device dependent on theoperator's preference. The distal component would be configured to beheld in place on the back end of the TEE probe and could be removed withthe correct amount of axial tension, once the TEE probe was successfullylocated in the esophagus. Once detached from the TEE probe, the TEECADdevice could be retracted and removed from the patient's esophagus.

In the preferred embodiment, the distal component would be configured tohouse the small video camera, lens, and light source, such as an LED.The internal wiring will comprise of a video feed wire, a power sourcefor the camera and LED. A control handle at the end of the device wouldprovide any needed controls for the video feed and for the LED. Thecamera can also be wireless, and the light source and camera may containan internal power supply, to reduce the need for some or all of thewires.

The removable or detachable carrier and camera of the present disclosurecan be used in other industries. For example, in the constructionindustry, a similar detachable device can be used to visualize theplacement of wires in a wall, where the wires are left behind and thecamera is detached from the wires and pulled back to the user.

Other objects and advantages of the present invention will becomeapparent to one having ordinary skill in the art after reading thespecification in light of the drawing figures, however, the spirit andscope of the present invention should not be limited to the descriptionof the embodiments contained herein. For example, electromagnetic strapsor a detachable sleeve can be used instead of the preferred embodimentto attach the carrier to the TEE probe during intubation. Theelectromagnetic straps could be de-energized once the TEE probe was inthe proper location for removal of the carrier. Further, a sleeve couldbe configured to encase the TEE probe. The sleeve can be detached andwithdrawn from the patient after intubation has occurred.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a functional block diagram view of an embodiment of a systemfor proper transesophageal echocardiography probe positioning by using acamera in accordance with the present disclosure;

FIG. 2 illustrates an embodiment of an apparatus for propertransesophageal echocardiography probe positioning by using a camera inaccordance with the present disclosure;

FIG. 3 illustrates an embodiment of an apparatus for propertransesophageal echocardiography probe positioning by using a camera inaccordance with the present disclosure;

FIG. 4 illustrates an alternative embodiment of an apparatus for propertransesophageal echocardiography probe positioning by using a camera inaccordance with the present disclosure;

FIG. 5 illustrates an alternative embodiment of a system for propertransesophageal echocardiography probe positioning by using a camera inaccordance with the present disclosure; and

FIG. 6 illustrates an alternative embodiment of a system for propertransesophageal echocardiography probe positioning by using a camera inaccordance with the present disclosure.

DETAILED DESCRIPTION

The present disclosure is an apparatus, system and related methodspertaining to an attachable and detachable TEECAD or TransesophagealEchocardiography Endoscopic Camera Assist Device. The TEECAD deviceincreases the functionality of currently existing probes by transmittingvideo information to a video monitor during the placement of the probe.The video information can be displayed on a video monitor, which may ormay not be separate from the echocardiography machine. In particular,the display monitor used during the transesophageal echocardiographyprocedure, allows the practitioner or cardiologist to see or visualizethe path of the TEE probe as it is inserted into the esophagus and movedinto position for the TEE procedure. The TEECAD device has minimalcircumference or girth and would not create an issue during intubation.Further, the TEACAD device is configured to be completely detachable,and easily retractable after a successful intubation of the esophagus,while leaving the TEE probe in place, as described in detail herein.

Referring to the drawings, wherein like reference numerals refer to thesame or similar features in the various views, FIG. 1 is a functionalblock diagram view of an exemplary TEECAD system 10 which is used toassist in proper Transesophageal Echocardiography (TEE) probepositioning with the use of a detachable camera system in accordancewith the present disclosure. The TEECAD system 10 comprises a TEECADprobe 12, which is combination of a TEECAD device 14, as shown in FIG.2, and a TEE probe 16, for which the distal end is partially shown inFIG. 3, but which generally are about 80 cm in length. The TEECAD probe12 also comprises, a lens 18, a camera 20, for a video feed, and a lightsource 22, such as an LED, along with the associated wiring 24 for thecamera 20 and light source 22, along with any necessary controls 26 tocontrol the camera 20, the light source 22, and any other devices orsystems, as necessary.

As understood by one having ordinary skill in the art, the camera can bewireless, and the light source and camera may contain internal powersupplies, thereby reducing the need for some or all of the wires.Further, the video feed from the camera 74 could be transmitted throughthe wire to a video monitor 30, which could be separate from theultrasound display 28, although it is not required. The video monitor 30can be placed near the device dependent on the cardiologist'spreference, although the video feed can be transmitted remotely foraccess to viewing the procedure offsite or for educational purposes,among others

In the preferred embodiment, the camera 20 is a NanEye 2D sensor byAWAIBA, which provides a system-on-chip camera head 20. The proprietarydata interface technology permits cable length's up to 3 meters withoutany additional components at the distal end. Further, due to the lowenergy dissipation on the interface, no complicated shielding isrequired to meet EMC norms. Also, a small lens 18 can be assembled tothe chip without increasing the total diameter of the sensor 20, makingit one of the most compact digital cameras 20.

The exemplary TEECAD system 10 further comprises a display 28 forshowing the ultrasonic results of the TEE probe 16 during a procedure,and a video monitor 30 for showing the video from the camera 20 as theTEECAD probe 12 is inserted into the esophagus and travels through theesophagus to the intended location. As described herein, the videomonitor 30 allows the cardiologist to see the location of the TEECADprobe 12 as it travels through the patient's esophagus and as the TEECADprobe 12, and in particular the TEE probe 16, as it is moved into theproper location for the ultrasonic portion of the procedure. The monitor30 and display 28 could be a single unit.

The present disclosure further contemplates that the camera 20 couldsend signals wirelessly to the monitor 30 or to a receiver (not shown)that could connect to a monitor 30, as understood by those havingordinary skill in the art. Further, as stated herein, the signalsreceived from the camera could be transmitted remotely for teaching oranalysis purposes.

FIG. 2 shows the preferred embodiment of the TEECAD device 14, whichcomprises a carrier 40. The carrier 40 comprises three separatecomponents, a distal component 42, a proximal component 44 (bothpreferably molded components), and a midsection lumen 46, preferablyconsisting of an extruded segment of polymer tubing 48. Although thecarrier 40 comprises three separate components, any one or more of thesecomponents can be combined to perform the same function as describedherein. For example, the mid-section lumen 46 and the proximal component44 can be combined into an integral section and used with a non-integraldistal component 42 to perform the same function as three separatecomponents.

In the preferred embodiment, the distal component 42 comprises a concavesection 50 configured to accept and support the distal portion of theTEE probe 16, and in particular, the distal component 42 is designed andconfigured to be removeably attached to and partially envelop the backside 52 of the TEE probe 16, opposite the ultrasound transducer 54, asshown in FIG. 3. The ultrasonic transducer 54 at the distal end isconnected to the shaft 56 of the TEE probe 16. The shape and material ofthe distal component 42 of the carrier 40 shall be designed to providesufficient mechanical stability to maintain communication with the backside 52 of the TEE probe 16 at the distal end, during TEACAD probe 12intubation.

During the intubation procedure, while the TEE probe is inserted intothe esophagus, the carrier will also be inserted into the esophagus. Atleast the distal component 42 and a portion of the mid-section lumen 46will be inserted into the esophagus during intubation. The design andconfiguration of the distal component 42 of the carrier 40 shall allowthe distal component 42, with minimal axial tension or pull, to detachfrom the back side 54 and distal end of the TEE probe 16, and to beretracted along the shaft 52 of the TEE probe 16 until the distalcomponent 42 is effectively removed from the patient's esophagus, orremoved to a distance that does not influence the TEE probe 16performance. The distal component 42 of the carrier 40 can be attachedto the back side 54 of the TEE probe 16 in a number of ways, as long asit can be detached after the TEE probe has been properly located, andremoved from the patient.

As also shown in FIG. 2, contained within the distal component 42 of thecarrier 40 will be an aperture 58 in which the camera 20, lens 18 andlight source 22 will be located. The camera 20 will have coincidentillumination 22 (built in), or in an alternative embodiment, an aperturein which only a camera 20 will be located and which will receiveancillary illumination 22 from a source not coincident to the camera 20.The ancillary illumination 22 may be located adjacent to the aperture 58or be contained within the distal component 42. The built in lens 18 ofthe camera 20 and the illumination 22 will be arranged at the furthestmost segment 60 of the distal component 42.

Although the preferred embodiment comprises a camera 20 and light sourceor LED 22 built directly into the carrier 40, an alternative embodimentcomprises a separate camera sheath (not shown) which comprises thecamera 20, the light source 22, and the associated wiring 24, thatinserts through the mid-section lumen 46 of the carrier 40. In thisembodiment, the camera sheath can be reused, while the carrier 40 isdiscarded after use.

FIG. 2 also shows the mid-section lumen 46 of the carrier 40, which inthe preferred embodiment, which will run alongside the shaft 56 of theTEE probe 16 during intubation. The mid-section lumen 46 will have asmaller diameter, approximately 5 to 6 mm in diameter, than the shaft 52of the probe 16. However, the mid-section lumen 46 shall be sufficientlythick to withstand the tensile force required to detach and withdraw thedistal component 42 from the back end 54 of the TEE probe 16 and aboutthe TEE probe shaft 52. The inside of the lumen 46 shall be sized andconfigured such that it shall contain the wiring 24 for the digitalcamera 20, or in some embodiments, the digital camera 20 and theillumination mechanism 22. In some embodiments, the lumen 46 shall bereinforced such that the cross-section of the lumen 46 may be minimized,but which still can provide adequate tensile force, such that the distalcomponent 42 may be retracted safely and effectively.

The proximal component 44 of the carrier 40 comprises a handle or clip64 that is configured to be removeably attached to the proximalcomponent 44 of the TEE probe 16. Although it is not necessary that theproximal component 46 attach to the TEE probe 16, the handle or clip 64may partly or fully encircle the proximal component 44, if it does. Theproximal component 44 may attach and, if a clip, be removed with aspring mechanism 66. Either way, the proximal component 44 will beconfigured with an opening 68 to accommodate the wiring 24 for thecamera 20 and LED 22.

The carrier 40, which is constructed of the three components, the distalcomponent 42, the lumen 46, and the proximal component 44, shall becontinuous, and constructed such that the components may be attached toeach other by conventional methods of cold vulcanization as well asusing heat or solvent bonding, as understood by one having ordinaryskill in the art.

The camera component in the preferred embodiment, such as the NanEye 2Dsensor by AWAIBA, shall include a video chip, LED lighting, and a clearpolymer lens covering the assembly. Although the NanEye 2D is thepreferred embodiment, the LED lighting may also be a separate componentfrom the camera embodiment, and possibly integrated directly into distalcomponent 42 of the carrier 40. Regardless, the digital camera 20 andillumination system 22 shall attach to an image processor (if necessary)and viewing monitor 30 which is located proximal to but not integral tothe carrier 40.

The present disclosure contemplates other embodiments in which a carriersimilar that described herein can be attached to a TEE probe 16 and, assuch, a TEACAD probe 12 can be inserted into the esophagus. Once the TEEprobe 16 is properly positioned (as viewed in the monitor 30), thedistal component 42 or equivalent of the carrier can be removed from thedistal portion of the TEE probe 16 opposite the ultrasonic transducer 54and the TEECAD device 14 can then be removed or withdrawn from theesophagus.

The present disclosure contemplates that the entire carrier 40, alongwith the camera 20 and light source 22, can be disposable once used, orthe camera 20 and light source 22 can be reused as described herein.Whether the entire device is discarded or a portion is reused willdepend on the overall cost and the possibility of sterilizing any partof the device after each use. In particular, the carrier 40, which isthe least expensive item, will be disposable. However, the camera 20 andlight source 22 may or may not be reusable. The camera 20 and LED 22 maybe incorporated directly into the carrier 40 if they are to be disposedof after use. If the camera 20 and LED 22 are to be sterilized andreused, then a separate thin camera sheath (not shown) containing thecamera 20 and the LED or light source 22, can be thread through thelumen 46 of the carrier 40, and then removed, sterilized or disinfected,and reused.

FIG. 4 shows an alternative embodiment of the present disclosure. In thealternative embodiment, a TEECAD device 70 comprises a shaft 72, whichcontains within the wires or cabling for a camera 74, light 76 andcontrol wires 78. The shaft 72 is a thin, mini-endoscope or lumen, whichcontains the wiring or cabling, and which would be attached to astandard TEE probe 16 during intubation. The shaft 72 comprisesadjustable straps 80 that would be configured to secure the TEECADdevice 70 to the TEE probe 16.

In the embodiment, the straps 80 would be held in place with smallelectromagnets 82 that could be activated and deactivated from controls84. In doing so, the electromagnets 82 could be energized to attach theTEECAD device 70 to the TEE probe 16 prior to insertion into theesophagus. As before, the combination of the TEE probe 16 with theattached TEECAD device 70 creates a TEECAD probe 12. Once the TEECADprobe 12 is successfully located in the proper position in the esophagusfor ultrasonic imaging, the electromagnets 82 could be de-energized,thereby allowing the TEECAD device 70 to detach from the TEE probe 16,and be extracted from the patient's esophagus.

In an embodiment, there would be four straps 80, two near the distal endfor stability of the camera 74, and two attached to the middle area ofthe shaft 72 of the TEECAD device 70. The straps 80 would be thin, andhave rounded edges, to assure minimal trauma to the esophagus duringintubation and removal of the TEECAD device 70. As shown in FIG. 5,cross-sectional view B-B, the distal end of the TEECAD device 70 wouldcomprise a small video camera 74, a lens 75, and an light source or LED76.

As shown in FIG. 6, cross-sectional view A-A, the internal wiring in theshaft 72 comprises a video feed wire 90 from the camera 74 to themonitor 30, a power source 92 for the light source or LED 76, and apower line 94 for the control wires 78, to control the energizing andde-energizing of the electromagnets 82 on the straps 80. The controls 84at the end of the TEECAD device 70 would provide the controls for thevideo feed 74, LED 76, and ability to activate and deactivate theelectromagnets 82 on the straps 80. As understood by one having ordinaryskill in the art, the camera can be wireless, and the light source maycontain an internal power supply, and the electromagnets may becontrolled remotely, to reduce the need for some or all of the wires,similar to all of the embodiments herein.

Similar to the discussion above, the video feed from the camera 74 couldbe transmitted through the wire to a video monitor 30, which could beseparate from the ultrasound display 28, although it is not required.The video monitor 30 can be placed near the device dependent on thecardiologist's preference, although the video feed can be transmittedremotely for access to viewing offsite or for educational purposes,among others.

In accordance with the alternative embodiment, by using the straps 80and energizing the electromagnets 82 with the controls 78, the shaft 72of the TEECAD device 70, with the integral camera 74 and lights 76, canbe attached to the TEE probe 16. The resulting TEECAD probe 12 can beinserted into the esophagus to reduce or minimize the risk of esophagealand pharyngeal complications, by allowing the cardiologist to directlyvisualize the pharyngeal and esophageal structures on the video monitor30 during intubation. Once the TEECAD probe 12 has been properlyinserted into the esophagus, the electromagnets 82 can be de-energizedusing the controls 84, thereby allowing the TEECAD device 70 to detachfrom the TEE probe 16, so that the TEECAD device 70 can be removed fromthe patient and the ultrasonic imaging on the display 28 can take place.

In an alternative embodiment, the TEECAD device can be a detachablesleeve, used instead of the electromagnetic straps 80. The sleeve couldbe configured to encase the TEE probe 16 and an endoscope and bedetached and withdrawn from the patient after intubation has occurred.

Various embodiments are described herein to various apparatuses,systems, and/or methods. Numerous specific details are set forth toprovide a thorough understanding of the overall structure, function,manufacture, and use of the embodiments as described in thespecification and illustrated in the accompanying drawings. It will beunderstood by those skilled in the art, however, that the embodimentsmay be practiced without such specific details. In other instances,well-known operations, components, and elements have not been describedin detail so as not to obscure the embodiments described in thespecification. Those of ordinary skill in the art will understand thatthe embodiments described and illustrated herein are non-limitingexamples, and thus it can be appreciated that the specific structuraland functional details disclosed herein may be representative and do notnecessarily limit the scope of the embodiments, the scope of which isdefined solely by the appended claims.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one embodiment,” or “an embodiment”, or the like, meansthat a particular feature, structure, or characteristic described inconnection with the embodiment is included in at least one embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one embodiment,” or “in an embodiment”, or the like,in places throughout the specification are not necessarily all referringto the same embodiment. Furthermore, the particular features,structures, or characteristics may be combined in any suitable manner inone or more embodiments. Thus, the particular features, structures, orcharacteristics illustrated or described in connection with oneembodiment may be combined, in whole or in part, with the featuresstructures, or characteristics of one or more other embodiments withoutlimitation given that such combination is not illogical ornonfunctional.

Although a number of embodiments have been described above with acertain degree of particularity, those skilled in the art could makenumerous alterations to the disclosed embodiments without departing fromthe spirit or scope of this disclosure. For example, all joinderreferences (e.g., attached, coupled, connected, and the like) are to beconstrued broadly and may include intermediate members between aconnection of elements and relative movement between elements. As such,joinder references do not necessarily infer that two elements aredirectly connected and in fixed relation to each other. As used herein,the phrased “configured to,” “configured for,” and similar phrasesindicate that the subject device, apparatus, or system is designedand/or constructed (e.g., through appropriate hardware, software, and/orcomponents) to fulfill one or more specific object purposes, not thatthe subject device, apparatus, or system is merely capable of performingthe object purpose. It is intended that all matter contained in theabove description or shown in the accompanying drawings shall beinterpreted as illustrative only and not limiting. Changes in detail orstructure may be made without departing from the spirit of thedisclosure as defined in the appended claims.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. An apparatus, comprising: a carrier having adistal section, a proximal section, and a medial section disposedbetween the distal section and the proximal section, the distal sectionincluding a camera and configured to be (1) removably coupled to animager head of a flexible transesophageal echocardiography (TEE)ultrasound device, and (2) inserted into an esophagus of a patient whenthe distal section is removably coupled to the imager head of the TEEultrasound device, the medial section configured to have a lengthsufficient to extend from the distal section through the esophagus andout the patient when (1) the distal section is removably coupleddirectly to the imager head, and (2) the imager head of the TEEultrasound device is disposed within a target imaging location of theesophagus, the target imaging location being adjacent and laterallyspaced from the heart such that the TEE ultrasound device can obtainimages of the heart, the distal section being configured to be removablycoupled to the imager head such that when the distal section and the TEEultrasound device are disposed within the target imaging location of theesophagus the distal section is releasable from the imager head andretractable relative to a body portion of the TEE ultrasound device inresponse to a proximal force applied to the medial section, leaving theimager head of the TEE ultrasound device disposed within the targetimaging location of the esophagus.
 2. The apparatus of claim 1, whereinthe proximal section is configured to removably attach to a proximal endportion of the TEE ultrasound device outside the patient when the TEEultrasound device is disposed within the target imaging location of theesophagus.
 3. The apparatus of claim 1, wherein the camera is configuredto capture image data within the esophagus, the distal section furtherincluding (1) a light source disposed within the distal section andconfigured to illuminate a portion of the esophagus, and (2) a couplerconfigured to releasably attach the distal section to the TEE ultrasounddevice.
 4. The apparatus of claim 1, wherein the camera iscommunicatively coupled to an image data processing device configured toprocess image data captured by the camera when the distal section isdisposed within the esophagus, the image processing device being locatedoutside the patient when both the distal section and TEE ultrasounddevice are disposed within the target imaging location of the esophagus.5. The apparatus of claim 1, wherein the imager head of the TEEultrasound device includes an imaging array, the distal sectionconfigured not to obstruct the imaging array when the distal section isremovably coupled to the imager head of the TEE ultrasound device. 6.The apparatus of claim 1, wherein the medial section defines a lumentherethrough, the apparatus further comprising a communication lineextending from the distal section through the lumen of the medialsection to outside the patient when both the distal section and the TEEultrasound device are disposed within the target imaging location of theesophagus.
 7. The apparatus of claim 1, wherein the medial sectionincludes at least one electromagnet configured to (1) secure the medialsection to a body portion of the TEE ultrasound device when the at leastone electromagnet is energized, and (2) release the medial section fromthe body portion of the TEE ultrasound device when the at least oneelectromagnet is de-energized.
 8. The apparatus of claim 7, wherein theelectromagnet is contained within an adjustable strap.
 9. The apparatusof claim 1, wherein the medial section includes a detachable sleeveconfigured to at least partially encase a portion of the TEE ultrasounddevice when attached.
 10. The apparatus of claim 1, wherein the imagerhead of the TEE ultrasound device includes an imaging array, the distalsection of the carrier defining a concave portion configured to at leastpartially envelop a portion of the imager head of the TEE ultrasounddevice, the portion of the imager head not including the imaging array.11. The apparatus of claim 1, wherein the camera is directed to captureimages distal to the distal section of the carrier and the imager headof the TEE ultrasound device when the distal section is attached to theimager head.
 12. The apparatus of claim 1, wherein the distal section ofthe carrier defines a concave portion configured to envelop a portion ofthe imager head of the TEE ultrasound device.
 13. The apparatus of claim1, wherein the distal section of the carrier is configured to envelop aportion of the imager head of the TEE ultrasound device such that thedistal section of the carrier can be slidably released from the imagerhead and retracted along a body portion of the TEE ultrasound device,leaving the imager head of the TEE ultrasound device disposed within thetarget imaging location of the esophagus.
 14. The apparatus of claim 1,wherein the distal section of the carrier is configured to besufficiently flexible to assume a shape imparted by the TEE ultrasounddevice and the esophagus when the distal section is removably coupled tothe imager head and inserted into the esophagus.
 15. The apparatus ofclaim 1, further comprising the TEE ultrasound device.
 16. The apparatusof claim 15, wherein the TEE ultrasound device is about 80 cm in length.17. An apparatus, comprising: a carrier having a distal section and amedial section extending from the distal section, the distal sectionincluding a camera and configured to be (1) removably coupled to animager head of a flexible transesophageal echocardiography (TEE)ultrasound device, and (2) inserted into an esophagus of a patient whenthe distal section is removably coupled to the imager head of the TEEultrasound device, the medial section configured to have a lengthsufficient to extend from the distal section through the esophagus andout the patient when (1) the distal section is removably coupleddirectly to the imager head, and (2) the imager head of the TEEultrasound device is disposed within the esophagus adjacent andlaterally spaced from the heart such that the TEE ultrasound device canobtain images of the heart, the distal section being removable from theimager head of the TEE ultrasound device and the esophagusintra-procedure in response to a proximal force applied to the medialsection.
 18. The apparatus of claim 17, wherein the camera iscommunicatively coupled to an image data processing device configured toprocess image data captured by the camera when the distal section isdisposed within the esophagus, the image processing device being locatedoutside the patient when both the distal section and TEE ultrasounddevice are disposed within a target imaging location of the esophagus.19. The apparatus of claim 17, wherein the medial section defines alumen therethrough, the apparatus further comprising a communicationline extending from the distal section through the lumen of the medialsection to outside the patient when both the distal section and the TEEultrasound device are disposed within a target imaging location of theesophagus.
 20. The apparatus of claim 17, wherein the medial sectionincludes a detachable sleeve configured to at least partially encase aportion of the TEE ultrasound device when attached.
 21. The apparatus ofclaim 17, wherein the imager head of the TEE ultrasound device includesan imaging array, the distal section of the carrier defining a concaveportion configured to at least partially envelop a portion of the imagerhead of the TEE ultrasound device, the portion of the imager head notincluding the imaging array.
 22. The apparatus of claim 17, wherein thecamera is directed to capture images distal to the distal section of thecarrier and the imager head of the TEE ultrasound device when the distalsection is attached to the imager head.
 23. The apparatus of claim 17,wherein the distal section of the carrier defines a concave portionconfigured to envelop a portion of the imager head of the TEE ultrasounddevice.